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Updated CPT codes: Few (and overdue), but mighty
Changes in procedural terminology (CPT) codes for 2006 include only 2 new codes and 1 revised code that directly affect ObGyn practices. Besides needing to know about the addition of a code for the revision of a vaginal graft and a new “add-on” code for reporting an endometrial biopsy with colposcopy, ObGyn practices will need to amend any encounter forms containing codes for confirmatory consultations or follow-up inpatient consultations, because all of these code sets will be deleted effective January 1, 2006.
Barbara S. Levy, MD
Obg Management
Board of Editors
Dr. Levy represents ACOG on the AMA-RBRVS Update Committee, and is ex-officio, ACOG Coding and Nomenclature committee.
At last, ACOG has succeeded in capturing the additional work of performing endometrial biopsy at the time of colposcopy with biopsies and/or endocervical curettage. The Centers for Medicare and Medicaid services had been bundling the work of endometrial sampling into the broader code for colposcopy with biopsies. The bundled code meant we did not get paid for these biopsies. Although that policy was clearly inappropriate, the fix was long in coming. Beginning January 1, 2006, we can use a new add-on code (+58110) when endometrial biopsy is performed with colposcopy (usually for patients with atypical glandular cells on Pap smear). It will be important to train ourselves and our staff to use the new code rather than attempt to use a modifier on the code for typical endometrial biopsy (58100).
New complications and misadventures sometimes ride in on the coattails of new technology, and must be corrected surgically. Along with the use of mesh to enhance pelvic reconstructive surgery has come the problem of mesh erosion. Removal of infected or eroding mesh is a nasty experience that, until now, had only an unspecified code, necessitating letters back and forth to payers and difficulty obtaining reimbursement. A new code properly describes the work performed in these difficult dissections: 57295.
No more “second opinion” codes.
Several redundant and difficult codes have been discarded. One of the last remnants of managed care, the confirmatory consultation (“second opinion”), has been removed from CPT.
In addition, follow-up consultations in the hospital were determined to be indistinguishable from subsequent hospital visits and therefore this category of codes was also eliminated.
Dr. Levy is Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash.
REVISION OF VAGINAL GRAFTNEW CODE: 57295
Ms. Ahad a cystocele repair 6 months ago. Her pubocervical fascia was so weak that a surgical mesh was placed to keep the bladder in position. She now complains of vaginal pain and discharge. Examination reveals the mesh has eroded into the vagina, and surgical repair is required. How would you code this situation?
In 2005, the only way to code this situation was to use the unlisted code 58999 because the existing code for revision of a graft (57287) is reserved for revision of a urethral sling for stress urinary incontinence.
The good news is that starting January 1, a new code (57295) can be used for revision (including removal) of prosthetic vaginal graft, vaginal approach. This code will apply when the original surgery that resulted in the complication with the graft was reported with any of the following codes: the add-on code 57267 (insertion of mesh or other prosthesis for repair of pelvic floor defect, each site), one of the colporrhaphy codes (54250–56265), the rectocele repair code 45560, or the abdominal approach colpopexy code 57280.
ENDOMETRIAL BIOPSYNEW CODE: 58110
Last month, Mrs. B’s Pap test found “AGC - atypical glandular cells”(ICD-9-CM code 795.00). Because of this finding, the physician will perform colposcopy and obtain endocervical and endometrial biopsies. How would you code this situation?
Unfortunately, until the end of 2005, the ObGyn can be paid only for the endocervical curettage because the endometrial biopsy code (58100) was bundled with the colposcopy codes, in the National Correct Coding Initiative rules.
An “add-on” code for endometrial biopsy can be reported when the procedure is performed at the time of colposcopy. The new code, +58110, endometrial sampling performed in conjunction with colposcopy (list separately in addition to the code for the primary procedure), is valued under the resource-based relative value scale for the intraservice work only.
Notes added under the colposcopy codes 57420, 57421, and 57452–57461 indicate that if endometrial biopsy is also performed, the new code 58110 should be added to the colposcopy code. Because 58110 is an “add-on” code, no modifier is required when billed with 1 of the colposcopy codes.
Vagina and cervical biopsies also unbundled.
Because of the addition of the new 58110 code, CPT also revised code 57421 to clarify that it is only for biopsy of the vagina and cervix (if performed), and not an endometrial biopsy.
2ndOPINION CODE KAPUTRELATIVE VALUE UNITS RAISED
Confirmatory consultation codes (99271–99275) will disappear on January 1—a welcome change for most practices because confirmatory consultation codes could not be used when counseling or coordinating care dominated the visit.
In the future, if the patient is seen for a confirmatory consultation, the physician should bill an inpatient or outpatient evaluation and management (E/M) code rather than a consultation. The rationale is that confirmatory consultations are requested by the patient, rather than by a qualified health care provider. If the second opinion is requested by a third party, for example to confirm that recommended surgery was medically indicated, adding modifier 32 (mandated services) is appropriate.
The follow-up inpatient consultation codes (99261–99263) will also be eliminated in 2006. The CPT guidelines for 2006 instruct the physician to report the subsequent hospital care codes (99231–99233) if the patient requires a follow-up visit after the initial inpatient consultation. This change is a positive one for ObGyns, however, because the relative value units for the hospital care codes are slightly higher than were the follow-up consultation codes.
Changes in procedural terminology (CPT) codes for 2006 include only 2 new codes and 1 revised code that directly affect ObGyn practices. Besides needing to know about the addition of a code for the revision of a vaginal graft and a new “add-on” code for reporting an endometrial biopsy with colposcopy, ObGyn practices will need to amend any encounter forms containing codes for confirmatory consultations or follow-up inpatient consultations, because all of these code sets will be deleted effective January 1, 2006.
Barbara S. Levy, MD
Obg Management
Board of Editors
Dr. Levy represents ACOG on the AMA-RBRVS Update Committee, and is ex-officio, ACOG Coding and Nomenclature committee.
At last, ACOG has succeeded in capturing the additional work of performing endometrial biopsy at the time of colposcopy with biopsies and/or endocervical curettage. The Centers for Medicare and Medicaid services had been bundling the work of endometrial sampling into the broader code for colposcopy with biopsies. The bundled code meant we did not get paid for these biopsies. Although that policy was clearly inappropriate, the fix was long in coming. Beginning January 1, 2006, we can use a new add-on code (+58110) when endometrial biopsy is performed with colposcopy (usually for patients with atypical glandular cells on Pap smear). It will be important to train ourselves and our staff to use the new code rather than attempt to use a modifier on the code for typical endometrial biopsy (58100).
New complications and misadventures sometimes ride in on the coattails of new technology, and must be corrected surgically. Along with the use of mesh to enhance pelvic reconstructive surgery has come the problem of mesh erosion. Removal of infected or eroding mesh is a nasty experience that, until now, had only an unspecified code, necessitating letters back and forth to payers and difficulty obtaining reimbursement. A new code properly describes the work performed in these difficult dissections: 57295.
No more “second opinion” codes.
Several redundant and difficult codes have been discarded. One of the last remnants of managed care, the confirmatory consultation (“second opinion”), has been removed from CPT.
In addition, follow-up consultations in the hospital were determined to be indistinguishable from subsequent hospital visits and therefore this category of codes was also eliminated.
Dr. Levy is Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash.
REVISION OF VAGINAL GRAFTNEW CODE: 57295
Ms. Ahad a cystocele repair 6 months ago. Her pubocervical fascia was so weak that a surgical mesh was placed to keep the bladder in position. She now complains of vaginal pain and discharge. Examination reveals the mesh has eroded into the vagina, and surgical repair is required. How would you code this situation?
In 2005, the only way to code this situation was to use the unlisted code 58999 because the existing code for revision of a graft (57287) is reserved for revision of a urethral sling for stress urinary incontinence.
The good news is that starting January 1, a new code (57295) can be used for revision (including removal) of prosthetic vaginal graft, vaginal approach. This code will apply when the original surgery that resulted in the complication with the graft was reported with any of the following codes: the add-on code 57267 (insertion of mesh or other prosthesis for repair of pelvic floor defect, each site), one of the colporrhaphy codes (54250–56265), the rectocele repair code 45560, or the abdominal approach colpopexy code 57280.
ENDOMETRIAL BIOPSYNEW CODE: 58110
Last month, Mrs. B’s Pap test found “AGC - atypical glandular cells”(ICD-9-CM code 795.00). Because of this finding, the physician will perform colposcopy and obtain endocervical and endometrial biopsies. How would you code this situation?
Unfortunately, until the end of 2005, the ObGyn can be paid only for the endocervical curettage because the endometrial biopsy code (58100) was bundled with the colposcopy codes, in the National Correct Coding Initiative rules.
An “add-on” code for endometrial biopsy can be reported when the procedure is performed at the time of colposcopy. The new code, +58110, endometrial sampling performed in conjunction with colposcopy (list separately in addition to the code for the primary procedure), is valued under the resource-based relative value scale for the intraservice work only.
Notes added under the colposcopy codes 57420, 57421, and 57452–57461 indicate that if endometrial biopsy is also performed, the new code 58110 should be added to the colposcopy code. Because 58110 is an “add-on” code, no modifier is required when billed with 1 of the colposcopy codes.
Vagina and cervical biopsies also unbundled.
Because of the addition of the new 58110 code, CPT also revised code 57421 to clarify that it is only for biopsy of the vagina and cervix (if performed), and not an endometrial biopsy.
2ndOPINION CODE KAPUTRELATIVE VALUE UNITS RAISED
Confirmatory consultation codes (99271–99275) will disappear on January 1—a welcome change for most practices because confirmatory consultation codes could not be used when counseling or coordinating care dominated the visit.
In the future, if the patient is seen for a confirmatory consultation, the physician should bill an inpatient or outpatient evaluation and management (E/M) code rather than a consultation. The rationale is that confirmatory consultations are requested by the patient, rather than by a qualified health care provider. If the second opinion is requested by a third party, for example to confirm that recommended surgery was medically indicated, adding modifier 32 (mandated services) is appropriate.
The follow-up inpatient consultation codes (99261–99263) will also be eliminated in 2006. The CPT guidelines for 2006 instruct the physician to report the subsequent hospital care codes (99231–99233) if the patient requires a follow-up visit after the initial inpatient consultation. This change is a positive one for ObGyns, however, because the relative value units for the hospital care codes are slightly higher than were the follow-up consultation codes.
Changes in procedural terminology (CPT) codes for 2006 include only 2 new codes and 1 revised code that directly affect ObGyn practices. Besides needing to know about the addition of a code for the revision of a vaginal graft and a new “add-on” code for reporting an endometrial biopsy with colposcopy, ObGyn practices will need to amend any encounter forms containing codes for confirmatory consultations or follow-up inpatient consultations, because all of these code sets will be deleted effective January 1, 2006.
Barbara S. Levy, MD
Obg Management
Board of Editors
Dr. Levy represents ACOG on the AMA-RBRVS Update Committee, and is ex-officio, ACOG Coding and Nomenclature committee.
At last, ACOG has succeeded in capturing the additional work of performing endometrial biopsy at the time of colposcopy with biopsies and/or endocervical curettage. The Centers for Medicare and Medicaid services had been bundling the work of endometrial sampling into the broader code for colposcopy with biopsies. The bundled code meant we did not get paid for these biopsies. Although that policy was clearly inappropriate, the fix was long in coming. Beginning January 1, 2006, we can use a new add-on code (+58110) when endometrial biopsy is performed with colposcopy (usually for patients with atypical glandular cells on Pap smear). It will be important to train ourselves and our staff to use the new code rather than attempt to use a modifier on the code for typical endometrial biopsy (58100).
New complications and misadventures sometimes ride in on the coattails of new technology, and must be corrected surgically. Along with the use of mesh to enhance pelvic reconstructive surgery has come the problem of mesh erosion. Removal of infected or eroding mesh is a nasty experience that, until now, had only an unspecified code, necessitating letters back and forth to payers and difficulty obtaining reimbursement. A new code properly describes the work performed in these difficult dissections: 57295.
No more “second opinion” codes.
Several redundant and difficult codes have been discarded. One of the last remnants of managed care, the confirmatory consultation (“second opinion”), has been removed from CPT.
In addition, follow-up consultations in the hospital were determined to be indistinguishable from subsequent hospital visits and therefore this category of codes was also eliminated.
Dr. Levy is Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash.
REVISION OF VAGINAL GRAFTNEW CODE: 57295
Ms. Ahad a cystocele repair 6 months ago. Her pubocervical fascia was so weak that a surgical mesh was placed to keep the bladder in position. She now complains of vaginal pain and discharge. Examination reveals the mesh has eroded into the vagina, and surgical repair is required. How would you code this situation?
In 2005, the only way to code this situation was to use the unlisted code 58999 because the existing code for revision of a graft (57287) is reserved for revision of a urethral sling for stress urinary incontinence.
The good news is that starting January 1, a new code (57295) can be used for revision (including removal) of prosthetic vaginal graft, vaginal approach. This code will apply when the original surgery that resulted in the complication with the graft was reported with any of the following codes: the add-on code 57267 (insertion of mesh or other prosthesis for repair of pelvic floor defect, each site), one of the colporrhaphy codes (54250–56265), the rectocele repair code 45560, or the abdominal approach colpopexy code 57280.
ENDOMETRIAL BIOPSYNEW CODE: 58110
Last month, Mrs. B’s Pap test found “AGC - atypical glandular cells”(ICD-9-CM code 795.00). Because of this finding, the physician will perform colposcopy and obtain endocervical and endometrial biopsies. How would you code this situation?
Unfortunately, until the end of 2005, the ObGyn can be paid only for the endocervical curettage because the endometrial biopsy code (58100) was bundled with the colposcopy codes, in the National Correct Coding Initiative rules.
An “add-on” code for endometrial biopsy can be reported when the procedure is performed at the time of colposcopy. The new code, +58110, endometrial sampling performed in conjunction with colposcopy (list separately in addition to the code for the primary procedure), is valued under the resource-based relative value scale for the intraservice work only.
Notes added under the colposcopy codes 57420, 57421, and 57452–57461 indicate that if endometrial biopsy is also performed, the new code 58110 should be added to the colposcopy code. Because 58110 is an “add-on” code, no modifier is required when billed with 1 of the colposcopy codes.
Vagina and cervical biopsies also unbundled.
Because of the addition of the new 58110 code, CPT also revised code 57421 to clarify that it is only for biopsy of the vagina and cervix (if performed), and not an endometrial biopsy.
2ndOPINION CODE KAPUTRELATIVE VALUE UNITS RAISED
Confirmatory consultation codes (99271–99275) will disappear on January 1—a welcome change for most practices because confirmatory consultation codes could not be used when counseling or coordinating care dominated the visit.
In the future, if the patient is seen for a confirmatory consultation, the physician should bill an inpatient or outpatient evaluation and management (E/M) code rather than a consultation. The rationale is that confirmatory consultations are requested by the patient, rather than by a qualified health care provider. If the second opinion is requested by a third party, for example to confirm that recommended surgery was medically indicated, adding modifier 32 (mandated services) is appropriate.
The follow-up inpatient consultation codes (99261–99263) will also be eliminated in 2006. The CPT guidelines for 2006 instruct the physician to report the subsequent hospital care codes (99231–99233) if the patient requires a follow-up visit after the initial inpatient consultation. This change is a positive one for ObGyns, however, because the relative value units for the hospital care codes are slightly higher than were the follow-up consultation codes.
Using new ICD-9 codes for everyday dilemmas
CODING DILEMMA
How do you prevent a “missed period” visit from being incorrectly assigned to the global obstetric package?
Sandra has missed her period and suspects she may be pregnant. You examine her and perform a urine pregnancy test, which confirms the gestation. After giving her a prescription for vitamins and a lab slip for prenatal testing, you ask her to make an appointment in 2 weeks to begin prenatal care.
Now we have a new code (V72.42, pregnancy examination or test) to report the first encounter with the patient at which pregnancy is confirmed. Before the latest batch of new codes, which took effect October 1, the American College of Obstetricians and Gynecologists (ACOG) recommended using ICD-9-CM code 626.8 (missed period) for this office visit, though the “missed period” code implied disease rather than pregnancy. ICD-9-CM rules mandate coding for what is known at the end of a visit. Previously, codes V22.0 or V22.1 (supervision of normal pregnancy) were the only choices.
This pregnancy is not yet being supervised. The visit to confirm pregnancy now will generally be a low-level evaluation and management (E/M) service and is billed outside the global obstetric package because the patient’s pregnancy is not yet being supervised. The new code V72.42 makes this clear.
Changes for the better
That’s just one of the welcome diagnostic code additions in the International Classification of Diseases–9th Edition–Clinical Modification, thanks to the efforts of ACOG.
Besides the new code for pregnancy confirmation, there are codes for:
- multiple pregnancy that has been reduced in number
- expanded genetic counseling and testing
- oocyte donor, blood typing, and other pregnancy-related codes abnormal Papanicolaou smear has simpler wording.
- 2 codes designate cancer therapy: chemotherapy or immunotherapy
- family history of osteoporosis
- personal history of urinary tract infections
- tracking overweight and obese patients
CERVICAL SCREENING
CODING DILEMMA
What is the best way to code low-risk HPV?
Greta, 42, undergoes cervical sampling by the Papanicolaou test and human papillomavirus (HPV) test; the latter is positive for low-risk HPV types.
Code 795.09, other abnormal Papanicolaou smear of cervix and cervical HPV, has been revised slightly. The example of when to assign this code now reads “cervical low-risk human papillomavirus (HPV) DNA test positive.”
Simpler wording. This revision has simplified the wording of the example, clarifying its use, and does not change how the code is reported.
PHYSICAL EXAM PRIOR TO PROCEDURE
CODING DILEMMA
How do you distinguish preop exams from specialized exams of a specific area or system?
Rachel, 42, is scheduled to undergo uterine artery embolization for fibroids, and you perform the preoperative examination.
V72.83, other specified preoperative examination, and V72.84, preoperative examination, unspecified, have been revised to clarify that they should be reported when a general physical examination was performed prior to surgery or a procedure.
History of specific problems
Several codes have been added to allow ObGyns to use more specific history information relating to the patient’s condition or concerns:
- V13.02, personal history of urinary (tract) infection
- V15.88, personal history of fall or risk for falling
- V17.81, family history of osteoporosis
- V18.9, family history of genetic disease carrier.
OBESITY
CODING DILEMMA
What code indicates overweight necessitating intervention?
Alisha is 32 and weighs 180 lb, a heavy load for her 5 ft 2 inch frame. She reports that her health insurance will cover her membership costs for any 1 of several weight loss programs, provided she can demonstrate that she is significantly overweight.
The concerns of the medical community about the increasing prevalence of overweight and obesity (and, more rarely, underweight) and the link to many disease conditions has prompted ICD-9-CM to add several new codes for reporting a woman’s weight.
Supports insurance claims? Code 278.02, overweight, was added and linked to the new codes that report the patient’s body mass index (BMI). The national standards classify a patient as underweight, normal, overweight, obese, or morbidly obese based on the documented BMI; this information may assist patients in receiving treatment for their obesity through insurance coverage.
To calculate BMI, multiply weight in pounds by 703/height in inches squared. The ideal BMI is 20 to 25. Underweight patients have a BMI of 19 or less.
Before the new code for overweight can be entered in Alisha’s case, her BMI would need to be documented at 25 or above. Since her BMI is 32.9, she would fall into the obese category, which includes BMIs of 30 to 34.9. Someone who is morbidly obese has a BMI of 40 or more, or a BMI of more than 35 with 1 or more comorbid conditions such as hypertension, heart disease, high cholesterol, diabetes, severe joint pain, or arthritis.
The new BMI codes (V85.0–V85.4) are reported for any adult older than 20. Next year, codes will be added for patients who are between 2 and 20 years of age.
MULTIPLE GESTATION
CODING DILEMMA
Should a pregnancy be coded differently after a fetal reduction procedure?
Mariana, 40, undergoes in vitro fertilization with implantation of 2 embryos, but later, because of her age and health (she has metabolic syndrome), requests fetal reduction for a singleton gestation.
Multifetal pregnancy reduction is billed using CPT code 59866, and we now have a new ICD-9-CM code to characterize such gestations after the procedure: 651.7X, multiple gestation following (elective) fetal reduction.
The last digit can be 0, episode of care unspecified; 1, delivered with or without mention of antepartum condition; or 3, antepartum condition or complication.
High risk remains. Though fetal reduction will generally reduce risk to the remaining fetuses, the pregnancy is still considered high-risk. ICD-9-CM staff have clarified that this code should be reported even if, as in Mariana’s case, the pregnancy is reduced to a singleton gestation, as fetal reduction is a complicating factor.
ABNORMAL GLUCOSE TOLERANCE
CODING DILEMMA
Is there a specific code for elevated glucose tolerance test?
At 28 weeks’ gestation, Rebecca reports symptoms suggesting hyperglycemia, so you order blood glucose testing, which reveals elevated glucose tolerance.
Code 648.8X, abnormal glucose tolerance, has been revised to include conditions classifiable as 790.21 through 790.29, and a note was added to report V58.67 for associated long-term (current) insulin use.
Codes 790.21 through 790.29 are used to report specific abnormal glucose findings and may be added as a secondary diagnosis to clarify the abnormal result in pregnancy. For instance, code 790.21 is reported if the patient has elevated fasting glucose, while 790.22 indicates she has an elevated glucose tolerance test, as in Rebecca’s case.
Other pregancy-related codes
Obstructed labor. In other pregnancy-related changes, ICD-9-CM has clarified use of 660.8X, other causes of obstructed labor, to require an additional code to identify the cause. For instance, if the internal orifice is total obstructed by a tumor, use code 660.8X as the primary diagnosis and 653.8X, disproportion of other origin.
Procreative management. V59.7, donor, egg (oocyte) (ovum) has been added, and includes five 5-digit codes for type of donor. Using them properly requires knowing the age and status (eg, anonymous or not) of the donor. If no information about the donor’s age is available, the unspecified code V59.70 is used. Otherwise the choices are V59.71 and V59.73 for anonymous donors under age 35 and 35 and over, respectively, and V59.72 and V59.74 for donors under age 35 and 35 and over, respectively, whose eggs are to go to a designated recipient.
Blood typing. V72.86, encounter for blood typing, now can be used to report testing of the father when the mother is Rh-negative. This information allows physicians to determine the risk of Rh sensitization in the fetus and decide whether immunoglobulin administration is necessary to prevent it during the remainder of the pregnancy.
CODING DILEMMA
How do you prevent a “missed period” visit from being incorrectly assigned to the global obstetric package?
Sandra has missed her period and suspects she may be pregnant. You examine her and perform a urine pregnancy test, which confirms the gestation. After giving her a prescription for vitamins and a lab slip for prenatal testing, you ask her to make an appointment in 2 weeks to begin prenatal care.
Now we have a new code (V72.42, pregnancy examination or test) to report the first encounter with the patient at which pregnancy is confirmed. Before the latest batch of new codes, which took effect October 1, the American College of Obstetricians and Gynecologists (ACOG) recommended using ICD-9-CM code 626.8 (missed period) for this office visit, though the “missed period” code implied disease rather than pregnancy. ICD-9-CM rules mandate coding for what is known at the end of a visit. Previously, codes V22.0 or V22.1 (supervision of normal pregnancy) were the only choices.
This pregnancy is not yet being supervised. The visit to confirm pregnancy now will generally be a low-level evaluation and management (E/M) service and is billed outside the global obstetric package because the patient’s pregnancy is not yet being supervised. The new code V72.42 makes this clear.
Changes for the better
That’s just one of the welcome diagnostic code additions in the International Classification of Diseases–9th Edition–Clinical Modification, thanks to the efforts of ACOG.
Besides the new code for pregnancy confirmation, there are codes for:
- multiple pregnancy that has been reduced in number
- expanded genetic counseling and testing
- oocyte donor, blood typing, and other pregnancy-related codes abnormal Papanicolaou smear has simpler wording.
- 2 codes designate cancer therapy: chemotherapy or immunotherapy
- family history of osteoporosis
- personal history of urinary tract infections
- tracking overweight and obese patients
CERVICAL SCREENING
CODING DILEMMA
What is the best way to code low-risk HPV?
Greta, 42, undergoes cervical sampling by the Papanicolaou test and human papillomavirus (HPV) test; the latter is positive for low-risk HPV types.
Code 795.09, other abnormal Papanicolaou smear of cervix and cervical HPV, has been revised slightly. The example of when to assign this code now reads “cervical low-risk human papillomavirus (HPV) DNA test positive.”
Simpler wording. This revision has simplified the wording of the example, clarifying its use, and does not change how the code is reported.
PHYSICAL EXAM PRIOR TO PROCEDURE
CODING DILEMMA
How do you distinguish preop exams from specialized exams of a specific area or system?
Rachel, 42, is scheduled to undergo uterine artery embolization for fibroids, and you perform the preoperative examination.
V72.83, other specified preoperative examination, and V72.84, preoperative examination, unspecified, have been revised to clarify that they should be reported when a general physical examination was performed prior to surgery or a procedure.
History of specific problems
Several codes have been added to allow ObGyns to use more specific history information relating to the patient’s condition or concerns:
- V13.02, personal history of urinary (tract) infection
- V15.88, personal history of fall or risk for falling
- V17.81, family history of osteoporosis
- V18.9, family history of genetic disease carrier.
OBESITY
CODING DILEMMA
What code indicates overweight necessitating intervention?
Alisha is 32 and weighs 180 lb, a heavy load for her 5 ft 2 inch frame. She reports that her health insurance will cover her membership costs for any 1 of several weight loss programs, provided she can demonstrate that she is significantly overweight.
The concerns of the medical community about the increasing prevalence of overweight and obesity (and, more rarely, underweight) and the link to many disease conditions has prompted ICD-9-CM to add several new codes for reporting a woman’s weight.
Supports insurance claims? Code 278.02, overweight, was added and linked to the new codes that report the patient’s body mass index (BMI). The national standards classify a patient as underweight, normal, overweight, obese, or morbidly obese based on the documented BMI; this information may assist patients in receiving treatment for their obesity through insurance coverage.
To calculate BMI, multiply weight in pounds by 703/height in inches squared. The ideal BMI is 20 to 25. Underweight patients have a BMI of 19 or less.
Before the new code for overweight can be entered in Alisha’s case, her BMI would need to be documented at 25 or above. Since her BMI is 32.9, she would fall into the obese category, which includes BMIs of 30 to 34.9. Someone who is morbidly obese has a BMI of 40 or more, or a BMI of more than 35 with 1 or more comorbid conditions such as hypertension, heart disease, high cholesterol, diabetes, severe joint pain, or arthritis.
The new BMI codes (V85.0–V85.4) are reported for any adult older than 20. Next year, codes will be added for patients who are between 2 and 20 years of age.
MULTIPLE GESTATION
CODING DILEMMA
Should a pregnancy be coded differently after a fetal reduction procedure?
Mariana, 40, undergoes in vitro fertilization with implantation of 2 embryos, but later, because of her age and health (she has metabolic syndrome), requests fetal reduction for a singleton gestation.
Multifetal pregnancy reduction is billed using CPT code 59866, and we now have a new ICD-9-CM code to characterize such gestations after the procedure: 651.7X, multiple gestation following (elective) fetal reduction.
The last digit can be 0, episode of care unspecified; 1, delivered with or without mention of antepartum condition; or 3, antepartum condition or complication.
High risk remains. Though fetal reduction will generally reduce risk to the remaining fetuses, the pregnancy is still considered high-risk. ICD-9-CM staff have clarified that this code should be reported even if, as in Mariana’s case, the pregnancy is reduced to a singleton gestation, as fetal reduction is a complicating factor.
ABNORMAL GLUCOSE TOLERANCE
CODING DILEMMA
Is there a specific code for elevated glucose tolerance test?
At 28 weeks’ gestation, Rebecca reports symptoms suggesting hyperglycemia, so you order blood glucose testing, which reveals elevated glucose tolerance.
Code 648.8X, abnormal glucose tolerance, has been revised to include conditions classifiable as 790.21 through 790.29, and a note was added to report V58.67 for associated long-term (current) insulin use.
Codes 790.21 through 790.29 are used to report specific abnormal glucose findings and may be added as a secondary diagnosis to clarify the abnormal result in pregnancy. For instance, code 790.21 is reported if the patient has elevated fasting glucose, while 790.22 indicates she has an elevated glucose tolerance test, as in Rebecca’s case.
Other pregancy-related codes
Obstructed labor. In other pregnancy-related changes, ICD-9-CM has clarified use of 660.8X, other causes of obstructed labor, to require an additional code to identify the cause. For instance, if the internal orifice is total obstructed by a tumor, use code 660.8X as the primary diagnosis and 653.8X, disproportion of other origin.
Procreative management. V59.7, donor, egg (oocyte) (ovum) has been added, and includes five 5-digit codes for type of donor. Using them properly requires knowing the age and status (eg, anonymous or not) of the donor. If no information about the donor’s age is available, the unspecified code V59.70 is used. Otherwise the choices are V59.71 and V59.73 for anonymous donors under age 35 and 35 and over, respectively, and V59.72 and V59.74 for donors under age 35 and 35 and over, respectively, whose eggs are to go to a designated recipient.
Blood typing. V72.86, encounter for blood typing, now can be used to report testing of the father when the mother is Rh-negative. This information allows physicians to determine the risk of Rh sensitization in the fetus and decide whether immunoglobulin administration is necessary to prevent it during the remainder of the pregnancy.
CODING DILEMMA
How do you prevent a “missed period” visit from being incorrectly assigned to the global obstetric package?
Sandra has missed her period and suspects she may be pregnant. You examine her and perform a urine pregnancy test, which confirms the gestation. After giving her a prescription for vitamins and a lab slip for prenatal testing, you ask her to make an appointment in 2 weeks to begin prenatal care.
Now we have a new code (V72.42, pregnancy examination or test) to report the first encounter with the patient at which pregnancy is confirmed. Before the latest batch of new codes, which took effect October 1, the American College of Obstetricians and Gynecologists (ACOG) recommended using ICD-9-CM code 626.8 (missed period) for this office visit, though the “missed period” code implied disease rather than pregnancy. ICD-9-CM rules mandate coding for what is known at the end of a visit. Previously, codes V22.0 or V22.1 (supervision of normal pregnancy) were the only choices.
This pregnancy is not yet being supervised. The visit to confirm pregnancy now will generally be a low-level evaluation and management (E/M) service and is billed outside the global obstetric package because the patient’s pregnancy is not yet being supervised. The new code V72.42 makes this clear.
Changes for the better
That’s just one of the welcome diagnostic code additions in the International Classification of Diseases–9th Edition–Clinical Modification, thanks to the efforts of ACOG.
Besides the new code for pregnancy confirmation, there are codes for:
- multiple pregnancy that has been reduced in number
- expanded genetic counseling and testing
- oocyte donor, blood typing, and other pregnancy-related codes abnormal Papanicolaou smear has simpler wording.
- 2 codes designate cancer therapy: chemotherapy or immunotherapy
- family history of osteoporosis
- personal history of urinary tract infections
- tracking overweight and obese patients
CERVICAL SCREENING
CODING DILEMMA
What is the best way to code low-risk HPV?
Greta, 42, undergoes cervical sampling by the Papanicolaou test and human papillomavirus (HPV) test; the latter is positive for low-risk HPV types.
Code 795.09, other abnormal Papanicolaou smear of cervix and cervical HPV, has been revised slightly. The example of when to assign this code now reads “cervical low-risk human papillomavirus (HPV) DNA test positive.”
Simpler wording. This revision has simplified the wording of the example, clarifying its use, and does not change how the code is reported.
PHYSICAL EXAM PRIOR TO PROCEDURE
CODING DILEMMA
How do you distinguish preop exams from specialized exams of a specific area or system?
Rachel, 42, is scheduled to undergo uterine artery embolization for fibroids, and you perform the preoperative examination.
V72.83, other specified preoperative examination, and V72.84, preoperative examination, unspecified, have been revised to clarify that they should be reported when a general physical examination was performed prior to surgery or a procedure.
History of specific problems
Several codes have been added to allow ObGyns to use more specific history information relating to the patient’s condition or concerns:
- V13.02, personal history of urinary (tract) infection
- V15.88, personal history of fall or risk for falling
- V17.81, family history of osteoporosis
- V18.9, family history of genetic disease carrier.
OBESITY
CODING DILEMMA
What code indicates overweight necessitating intervention?
Alisha is 32 and weighs 180 lb, a heavy load for her 5 ft 2 inch frame. She reports that her health insurance will cover her membership costs for any 1 of several weight loss programs, provided she can demonstrate that she is significantly overweight.
The concerns of the medical community about the increasing prevalence of overweight and obesity (and, more rarely, underweight) and the link to many disease conditions has prompted ICD-9-CM to add several new codes for reporting a woman’s weight.
Supports insurance claims? Code 278.02, overweight, was added and linked to the new codes that report the patient’s body mass index (BMI). The national standards classify a patient as underweight, normal, overweight, obese, or morbidly obese based on the documented BMI; this information may assist patients in receiving treatment for their obesity through insurance coverage.
To calculate BMI, multiply weight in pounds by 703/height in inches squared. The ideal BMI is 20 to 25. Underweight patients have a BMI of 19 or less.
Before the new code for overweight can be entered in Alisha’s case, her BMI would need to be documented at 25 or above. Since her BMI is 32.9, she would fall into the obese category, which includes BMIs of 30 to 34.9. Someone who is morbidly obese has a BMI of 40 or more, or a BMI of more than 35 with 1 or more comorbid conditions such as hypertension, heart disease, high cholesterol, diabetes, severe joint pain, or arthritis.
The new BMI codes (V85.0–V85.4) are reported for any adult older than 20. Next year, codes will be added for patients who are between 2 and 20 years of age.
MULTIPLE GESTATION
CODING DILEMMA
Should a pregnancy be coded differently after a fetal reduction procedure?
Mariana, 40, undergoes in vitro fertilization with implantation of 2 embryos, but later, because of her age and health (she has metabolic syndrome), requests fetal reduction for a singleton gestation.
Multifetal pregnancy reduction is billed using CPT code 59866, and we now have a new ICD-9-CM code to characterize such gestations after the procedure: 651.7X, multiple gestation following (elective) fetal reduction.
The last digit can be 0, episode of care unspecified; 1, delivered with or without mention of antepartum condition; or 3, antepartum condition or complication.
High risk remains. Though fetal reduction will generally reduce risk to the remaining fetuses, the pregnancy is still considered high-risk. ICD-9-CM staff have clarified that this code should be reported even if, as in Mariana’s case, the pregnancy is reduced to a singleton gestation, as fetal reduction is a complicating factor.
ABNORMAL GLUCOSE TOLERANCE
CODING DILEMMA
Is there a specific code for elevated glucose tolerance test?
At 28 weeks’ gestation, Rebecca reports symptoms suggesting hyperglycemia, so you order blood glucose testing, which reveals elevated glucose tolerance.
Code 648.8X, abnormal glucose tolerance, has been revised to include conditions classifiable as 790.21 through 790.29, and a note was added to report V58.67 for associated long-term (current) insulin use.
Codes 790.21 through 790.29 are used to report specific abnormal glucose findings and may be added as a secondary diagnosis to clarify the abnormal result in pregnancy. For instance, code 790.21 is reported if the patient has elevated fasting glucose, while 790.22 indicates she has an elevated glucose tolerance test, as in Rebecca’s case.
Other pregancy-related codes
Obstructed labor. In other pregnancy-related changes, ICD-9-CM has clarified use of 660.8X, other causes of obstructed labor, to require an additional code to identify the cause. For instance, if the internal orifice is total obstructed by a tumor, use code 660.8X as the primary diagnosis and 653.8X, disproportion of other origin.
Procreative management. V59.7, donor, egg (oocyte) (ovum) has been added, and includes five 5-digit codes for type of donor. Using them properly requires knowing the age and status (eg, anonymous or not) of the donor. If no information about the donor’s age is available, the unspecified code V59.70 is used. Otherwise the choices are V59.71 and V59.73 for anonymous donors under age 35 and 35 and over, respectively, and V59.72 and V59.74 for donors under age 35 and 35 and over, respectively, whose eggs are to go to a designated recipient.
Blood typing. V72.86, encounter for blood typing, now can be used to report testing of the father when the mother is Rh-negative. This information allows physicians to determine the risk of Rh sensitization in the fetus and decide whether immunoglobulin administration is necessary to prevent it during the remainder of the pregnancy.
Pregnancy state affects CMV test code
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Can nurse-midwife bill for prolonged physician services?
To report these codes, the typical time included in the base inpatient service you are billing for must be exceeded by 30 minutes. For instance, code 99222 (initial hospital care, requiring a comprehensive history; a comprehensive exam and medical decision making of moderate complexity) has a typical time of 50 minutes. Since in your example the CNM spent only 1 hour face-to-face with the patient on the admission day, the criterion for reporting prolonged services has not been met and code 99356 cannot be billed in addition to 99222.
On the second day, however, prolonged services can be billed. Let’s use the example of 6 hours and assume the subsequent hospital care code billed on that day was 99233 (subsequent hospital care, requiring high complexity of medical decision making and a detailed history or exam). The typical time for this code is 35 minutes.
To determine billable prolonged service time, subtract typical time from the total face-to-face time (in this case 360 minutes), then subtract 30 because the first 30 minutes of prolonged time is not reported (360–35–30=295). Thus on day 2 you could bill 99233, plus 99356×1 for the first hour of prolonged service, and 99357×8 for the 8 remaining half-hour increments of prolonged time.
Two caveats, however. First, CPT nomenclature for the prolonged services codes indicate “physician service,” which means that some payers may not reimburse for prolonged services unless provided by a physician.
Second, if the CNM is unable to bill for the global service, but instead must itemize the services provided by billing separately for antepartum care (eg, 59426, antepartum care only; 7 or more visits) and postpartum care (59430, postpartum care only [separate procedure]), some payers may include the time spent with the laboring patient as part of the antepartum services. Check with the individual payer to see if they have a written policy regarding this situation.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
To report these codes, the typical time included in the base inpatient service you are billing for must be exceeded by 30 minutes. For instance, code 99222 (initial hospital care, requiring a comprehensive history; a comprehensive exam and medical decision making of moderate complexity) has a typical time of 50 minutes. Since in your example the CNM spent only 1 hour face-to-face with the patient on the admission day, the criterion for reporting prolonged services has not been met and code 99356 cannot be billed in addition to 99222.
On the second day, however, prolonged services can be billed. Let’s use the example of 6 hours and assume the subsequent hospital care code billed on that day was 99233 (subsequent hospital care, requiring high complexity of medical decision making and a detailed history or exam). The typical time for this code is 35 minutes.
To determine billable prolonged service time, subtract typical time from the total face-to-face time (in this case 360 minutes), then subtract 30 because the first 30 minutes of prolonged time is not reported (360–35–30=295). Thus on day 2 you could bill 99233, plus 99356×1 for the first hour of prolonged service, and 99357×8 for the 8 remaining half-hour increments of prolonged time.
Two caveats, however. First, CPT nomenclature for the prolonged services codes indicate “physician service,” which means that some payers may not reimburse for prolonged services unless provided by a physician.
Second, if the CNM is unable to bill for the global service, but instead must itemize the services provided by billing separately for antepartum care (eg, 59426, antepartum care only; 7 or more visits) and postpartum care (59430, postpartum care only [separate procedure]), some payers may include the time spent with the laboring patient as part of the antepartum services. Check with the individual payer to see if they have a written policy regarding this situation.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
To report these codes, the typical time included in the base inpatient service you are billing for must be exceeded by 30 minutes. For instance, code 99222 (initial hospital care, requiring a comprehensive history; a comprehensive exam and medical decision making of moderate complexity) has a typical time of 50 minutes. Since in your example the CNM spent only 1 hour face-to-face with the patient on the admission day, the criterion for reporting prolonged services has not been met and code 99356 cannot be billed in addition to 99222.
On the second day, however, prolonged services can be billed. Let’s use the example of 6 hours and assume the subsequent hospital care code billed on that day was 99233 (subsequent hospital care, requiring high complexity of medical decision making and a detailed history or exam). The typical time for this code is 35 minutes.
To determine billable prolonged service time, subtract typical time from the total face-to-face time (in this case 360 minutes), then subtract 30 because the first 30 minutes of prolonged time is not reported (360–35–30=295). Thus on day 2 you could bill 99233, plus 99356×1 for the first hour of prolonged service, and 99357×8 for the 8 remaining half-hour increments of prolonged time.
Two caveats, however. First, CPT nomenclature for the prolonged services codes indicate “physician service,” which means that some payers may not reimburse for prolonged services unless provided by a physician.
Second, if the CNM is unable to bill for the global service, but instead must itemize the services provided by billing separately for antepartum care (eg, 59426, antepartum care only; 7 or more visits) and postpartum care (59430, postpartum care only [separate procedure]), some payers may include the time spent with the laboring patient as part of the antepartum services. Check with the individual payer to see if they have a written policy regarding this situation.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Is discount unfair for outpatient ablation?
In the office setting the practice expense portion of the relative value assigned to a procedure is higher than when the procedure is performed in an outpatient setting, which does not incur the expense of supplies, treatment room, anesthesia, and equipment. The physician is still reimbursed the same for the physician work and malpractice elements of the procedure’s relative value, but the total RVU is less because the practice expense portion is less.
A physician would be paid at the lower RVU level for a facility setting, for performing a procedure in a hospital outpatient department, under Medicare rules, since the outpatient facility has incurred the expenses of staffing the procedure as well as the expensive disposable equipment.
The only exception to this rule is when a procedure performed in this setting does not appear on the ambulatory surgical center (ASC) list of procedures. In that case, the higher nonfacility fee allowance would be reimbursed. Unfortunately, both codes for an endometrial ablation—58353 (endometrial ablation, thermal, without hysteroscopic guidance) and 58563 (hysteroscopy surgical; with endometrial ablation)—appear on the ASC list.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
In the office setting the practice expense portion of the relative value assigned to a procedure is higher than when the procedure is performed in an outpatient setting, which does not incur the expense of supplies, treatment room, anesthesia, and equipment. The physician is still reimbursed the same for the physician work and malpractice elements of the procedure’s relative value, but the total RVU is less because the practice expense portion is less.
A physician would be paid at the lower RVU level for a facility setting, for performing a procedure in a hospital outpatient department, under Medicare rules, since the outpatient facility has incurred the expenses of staffing the procedure as well as the expensive disposable equipment.
The only exception to this rule is when a procedure performed in this setting does not appear on the ambulatory surgical center (ASC) list of procedures. In that case, the higher nonfacility fee allowance would be reimbursed. Unfortunately, both codes for an endometrial ablation—58353 (endometrial ablation, thermal, without hysteroscopic guidance) and 58563 (hysteroscopy surgical; with endometrial ablation)—appear on the ASC list.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
In the office setting the practice expense portion of the relative value assigned to a procedure is higher than when the procedure is performed in an outpatient setting, which does not incur the expense of supplies, treatment room, anesthesia, and equipment. The physician is still reimbursed the same for the physician work and malpractice elements of the procedure’s relative value, but the total RVU is less because the practice expense portion is less.
A physician would be paid at the lower RVU level for a facility setting, for performing a procedure in a hospital outpatient department, under Medicare rules, since the outpatient facility has incurred the expenses of staffing the procedure as well as the expensive disposable equipment.
The only exception to this rule is when a procedure performed in this setting does not appear on the ambulatory surgical center (ASC) list of procedures. In that case, the higher nonfacility fee allowance would be reimbursed. Unfortunately, both codes for an endometrial ablation—58353 (endometrial ablation, thermal, without hysteroscopic guidance) and 58563 (hysteroscopy surgical; with endometrial ablation)—appear on the ASC list.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Use -58 modifier only when D&C is planned
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
Code for hemorrhage depends on timing
Note that the code 666.1X, other immediate postpartum hemorrhage, is bleeding within the first 24 hours of delivery, but after delivery of the placenta.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Note that the code 666.1X, other immediate postpartum hemorrhage, is bleeding within the first 24 hours of delivery, but after delivery of the placenta.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Note that the code 666.1X, other immediate postpartum hemorrhage, is bleeding within the first 24 hours of delivery, but after delivery of the placenta.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
Excised lesions are coded by diameter
Unless the physician has indicated in the operative note that a simple partial vulvectomy was performed (eg, with more extensive lesions), I would pick codes that represent a benign or premalignant lesion.
If the lesion was excised, the code choice would be one of 11420 through 11426 (excision, benign lesion including margins, except skin tags [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter […]). Each code in this series specifies a different lesion diameter (≤0.5 cm up to >4.0 cm); you would select the code based on the greatest clinical diameter of the lesion plus the margin required for complete excision.
If the lesion was destroyed, the code 56501 (destruction of lesion[s], vulva; simple) or 56515 (destruction of lesion[s], vulva; extensive) would be reported instead.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Unless the physician has indicated in the operative note that a simple partial vulvectomy was performed (eg, with more extensive lesions), I would pick codes that represent a benign or premalignant lesion.
If the lesion was excised, the code choice would be one of 11420 through 11426 (excision, benign lesion including margins, except skin tags [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter […]). Each code in this series specifies a different lesion diameter (≤0.5 cm up to >4.0 cm); you would select the code based on the greatest clinical diameter of the lesion plus the margin required for complete excision.
If the lesion was destroyed, the code 56501 (destruction of lesion[s], vulva; simple) or 56515 (destruction of lesion[s], vulva; extensive) would be reported instead.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Unless the physician has indicated in the operative note that a simple partial vulvectomy was performed (eg, with more extensive lesions), I would pick codes that represent a benign or premalignant lesion.
If the lesion was excised, the code choice would be one of 11420 through 11426 (excision, benign lesion including margins, except skin tags [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter […]). Each code in this series specifies a different lesion diameter (≤0.5 cm up to >4.0 cm); you would select the code based on the greatest clinical diameter of the lesion plus the margin required for complete excision.
If the lesion was destroyed, the code 56501 (destruction of lesion[s], vulva; simple) or 56515 (destruction of lesion[s], vulva; extensive) would be reported instead.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
Can perineoplasty be coded with A&P repair?
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
Has Medicare corrected cryoablation RVUs yet?
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media